[Which screening for Leishmania infantum in asymptomatic blood donors?]. / Leishmania infantum e donatori di sangue: quale screening?

Leishmaniasis is a protozoan infection endemic in Italy with a greatly underestimated prevalence. The recent documentation of parasitaemia in blood donors is a cause of concern for blood safety. Because there is no screening against leishmania, we performed a study to assess the presence of protozoa in blood donors of Siena district (Tuscany) during the seasonal activity of the vector. From June to October 2007, 162 patients were screened for Leishmania infantum by indirect immunofluorescence serology (IFAT) and PCR for kinetoplast (kDNA). No subject was positive for antibodies, while 11 samples (6.8%) were positive for kDNA. A second PCR (nested-PCR) was negative for all kDNA positive individuals and other subjects for a total of 55 samples (33% of total subjects). The sequence analysis of three samples positive for kDNA was compatible with mitochondrial DNA. Through the techniques used, we were unable to confirm the presence of leishmania in the blood of the subjects studied. The choice of the diagnostic protocol in blood donors remains an open issue as molecular analysis (kDNA) seems to suggest, in our experience, limits of specificity.

Pneumococcal disease in a paediatric population in a hospital of central Italy: a clinical and microbiological case series from 1992 to 2006.

OBJECTIVES: Streptococcus pneumoniae is frequently isolated from carrier children, but it also causes localized and invasive diseases. Increasing incidence of chemoresistance can affect the efficacy of empiric therapy and it motivates interest in primary prophylaxis. The study aims to investigate clinical and microbiological features of paediatric pneumococcal infections in an Italian province. METHODS: Retrospective clinical analysis of 640 children, hospitalized from 1992 to 2006 with one culture positive for S. pneumoniae, was performed. Chemosusceptibility tests and serotyping were carried out on isolates; statistical analysis was applied to compare variables. RESULTS: Overall, 47.8% were carriers, 49% and 3.2% had, respectively, a localized or invasive disease; S. pneumoniae aetiology accounted for 25% of meningitis and 16% of sepsis. On the total isolates, 10.2% were penicillin non-susceptible, 35.15% were erythromycin resistant, with increasing rates over years. Prevalent invasive serotypes were 1 (38.1%) and 7F (9.5%). CONCLUSIONS: The study sustains pneumococcal disease relevance in children, on the strength of a 15 year observation. Long time period can represent a limit due to population characteristics changing; a selection bias could also be present due to hospitalized only patient analysis. However, we documented variable evolution of chemoresistance and a peculiar serotype spreading, offering microbiological basis for an appropriate clinical approach.